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August 30, 2007

Women Smokers Have Higher Risk For Head And Neck Cancer Than Men

Topics: Medicine

head%20neck%20cancer.jpgIn response to a reader's question regarding the risk for head and neck cancer in women who smoke, we note a recently published article in the journal Cancer that reported women have a higher risk than men and that smoking will increase their risk of developing head and neck cancer:

Head and neck cancer refers to several types of cancers including, but not limited to, cancer of the tongue, gums, oral cavity, nasal cavity, voice box, and back of the throat. Although men have a higher rate of head and neck cancer than women, incidence of head and neck cancer in women has been increasing significantly throughout the world.

Once head and neck cancer has spread from its site of origin, survival rates decrease dramatically. As well, treatment for more advanced head and neck cancer is often associated with significant declines in quality of life, as surgery often disfigures patients and/or severely impairs their ability to perform basic functions such as chew, swallow, or speak. Radiation that includes the salivary glands may also cause extremely dry mouth or sores in the mouth.

Smoking has already been established as a risk factor for developing head and neck cancer. However, data is limited about female smokers and their particular risk of head and neck cancer. Researchers affiliated with the National Cancer Institute recently conducted a clinical study to explore the association between cigarette smoking and head and neck cancer in women. This study included over 476,000 men and women, aged 50-71 years. From 1995 through 2000, 584 men and 175 women were diagnosed with cancer.

* Overall, men had a higher incidence of head and neck cancer than women.
* Smoking, however, caused a greater proportion of head and neck cancer in women than in men (75% versus 45%, respectively).

The researchers concluded: "Cigarette smoking is a strong risk factor for head and neck cancer in both men and women. Incidence rates of head and neck cancer were higher in male smokers than female smokers, but smoking may explain a higher proportion of head and neck cancer in women than in men." Individuals who smoke may wish to speak with their physician regarding smoking cessation programs.

Reference: Freedman N, Abnet C, Leitzmann M, et al. Prospective investigation of the cigarette smoking-head and neck cancer association by sex. Cancer [early online publication]. August 10 2007. DOI: 10.1002/cncr.22957.

There are three main types of treatment for managing head and neck cancer: Radiation therapy, surgery and chemotherapy, with radiation therapy or surgery, or both combined, being the primary treatments; chemotherapy is sometimes used as an additional, or adjuvant, treatment, with concomitant chemotherapy and radiation therapy having exhibited a favorable survival rate, particularly in radiotherapy and concomitant intraarterial cisplatin for advanced squamous cell carcinomas of the head and neck.

However, the optimal combination of the three treatment modalities for a patient with a particular head and neck cancer depends on the site of the cancer and the extent of the disease, and patients with early-stage head and neck cancers (particularly those limited to the site of origin) are generally treated with one modality--either radiation therapy or surgery.

Posted on 8/29 at New Hope Cancer Blog

Posted by Richard at August 30, 2007 9:32 AM

Actually Richard, the reason for the disparity probably has nothing to do with sensitivity to carcinogens. It has everything to do with HPV-16 and the increase in both the number of sexual partners and the prevalence of oral sex practices since the 60's. 72% of tumors studied had genetic markers for HPV-16. 2x the number of partners means 8x the chance that you are exposed to STD's.

oral and throat cancer rates are flat, but tobacco use is falling, therefore HPV would appear to be a larger risk factor.

http://www.claytoncramer.com/weblog/2007_08_26_archive.html#7871362203994752767

Posted by: Rorschach at August 30, 2007 9:48 AM

Unquestionably, HPV does indeed play a role in HNC, but smoking does at least as significantly, and in women, more so, especially since smoking in women has not been decreasing worldwide, rather, it's been increasing (note journal link). Also, over the years in my clinical research I've found hazard ratios to be quite predictive, and as the same article discusses, the hazard ratios associated with smoking were significantly larger in women (12.96; 95% confidence interval [CI], 7.81-21.52) than in men (5.45, 95% CI, 4.22-7.05; P for interaction:

Posted by: Richard at August 30, 2007 10:06 AM

Just thought I'd add one more little note. Although I've not been a smoker, I did have stage IV SCCHNC, twice, and so far, am still alive and kicking. I do admit, though, to a different type of "pleasure," and yes, HPV is a likely candidate.

And immunosuppression resulting from treatment for MS, in juxtaposition with HPV exposure,isn't a favorable combination and I wouldn't even want to think about the hazard ratios for it.

Posted by: Richard at August 30, 2007 10:15 AM

Richard, did that study try to account for and correct for HPV exposure or multiple sex partners? I did not get that impression, I will go back and re-read. Since on the whole women are more prone to be on the receiving end of oral sex, it would seem rational to think that it would play a large role.

Posted by: Rorschach at August 30, 2007 11:35 AM

"Since on the whole women are more prone to be on the receiving end
of oral sex, it would seem rational to think that it would play a large role."
I've never heard of any reports on women getting HPV from oral sex. Men, yes. Again, the hazard ratio tells us that irrespective of other factors, the smoking correlates very significantly with HNC.

Again, no one is saying that HPV doesn't play a role, it does; however, smoking is a double wammy, not only is it a carcinogen, it's also strongly immunosuppressive (HPV could also be, but it can also be immunopotentiating, at times).

The article posted on does indicate a correlation between smoking and HNC, that was the point of the post. It didn't address the question of synergy between polycyclic aromatic hydrocarbons, nicotine, etc., and HPV in HNC. However, it just so happens, such synergy does exist.

Posted by: Richard at August 30, 2007 11:57 AM

Posted by: Richard at August 30, 2007 12:01 PM

By "receiving end" I meant receiving her partner's penis in her mouth, Fellatio not Cunnilingus. I perhaps was not as clear in my meaning as I could have been. Mea Culpa.

Your second link clearly does indicate that smoking is coincident with HPV leading to cervical cancer, but we must not lose sight of the fact that coincidence is not proof of causation. There could conceivably be a third component that is common to both, such as sexual behavior etc.

Multiple sex partners could mean that the people with HPV-16 that go on to develop cancers may be more likely to be exposed to a sub-type that is more prone to go on to cause cancer. Smoking is a behavior that is often coincident with other risk taking behaviors such as drug use, multiple sex partners, risky sexual behavior (not using condoms etc.) etc.

Like HIV positive people who have unprotected sex with other HIV positive people, they often end up with multiple subtypes that are more difficult to treat than the subtype they were originally infected with. And the subtypes can trade genetic material with each other leading to hybrid subtypes. Concievably, HPV could hybridize in a similar manner.

Posted by: Rorschach at August 30, 2007 4:05 PM

We seem to have gotten a bit carried away here on a simple post that states what a research group reported.

I've had a long day, still would like to get up a few posts, have several projects going on that needs my attention, and I'm getting hungry.

Smoking isn't healthy, women have a higher hazard ratio than men in HNC, HPV can be contributory, so can a plethora of other factors, and we can beat this horse to the cows come home, but I'd rather not.

Have enjoyed the dialogue, but it's time for me to move on to other things today. Again, other factors may indeed come into play, but in the multiple research studies smoking is unquestionably a high-risk factor in SCHNC, especially in women, as is any form of tobacco use, and yes, so is HPV, Solumedrol, and any other immunosuppressive drug, etc..

Whether a man or a woman, but especially a woman, smoking places one at a higher risk for SCCHNC. The same goes for oral sex in both sexes, but the post was on the smoking issue. There's a lot of what ifs out there, but the post was on the smoking issue in women.

But I've already spent 30 years doing what ifs and what fors in cancer research and drug development, and would much rather do something new for relaxation - like blog, eat a bagle, and move on to another topic.

As always, been fun.

Posted by: Richard at August 30, 2007 4:46 PM



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